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1.
Clin Rehabil ; : 2692155211036956, 2021 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-34344230

RESUMO

OBJECTIVE: To find and compare the clinical and psychological effects of low and high-intensity aerobic training combined with resistance training in community-dwelling older men with post-COVID-19 sarcopenia symptoms. DESIGN: Randomized control trial. SETTING: University physiotherapy clinic. PARTICIPANTS: Men in the age range of 60-80 years with post-COVID-19 Sarcopenia. INTERVENTION: All participants received resistance training for whatever time of the day that they received it, and that in addition they were randomized into two groups like low-intensity aerobic training group (n = 38) and high-intensity aerobic training group (n = 38) for 30 minutes/session, 1 session/day, 4 days/week for 8 weeks. OUTCOMES: Clinical (muscle strength and muscle mass) and psychological (kinesiophobia and quality of life scales) measures were measured at the baseline, fourth week, the eighth week, and at six months follow-up. RESULTS: The 2 × 4 group by time repeated measures MANOVA with corrected post-hoc tests for six dependent variables shows a significant difference between the groups (P < 0.001). At the end of six months follow up, the handgrip strength, -3.9 (95% CI -4.26 to -3.53), kinesiophobia level 4.7 (95% CI 4.24 to 5.15), and quality of life -10.4 (95% CI -10.81 to -9.9) shows more improvement (P < 0.001) in low-intensity aerobic training group than high-intensity aerobic training group, but in muscle mass both groups did not show any significant difference (P > 0.05). CONCLUSION: Low-intensity aerobic training exercises are more effective in improving the clinical (muscle strength) and psychological (kinesiophobia and quality of life) measures than high-intensity aerobic training in post-COVID 19 Sarcopenia.

2.
Artigo em Inglês | MEDLINE | ID: mdl-34422082

RESUMO

Results: The results of the a-ACLR, c-ACLR, and control groups were compared. At 8 weeks following postoperative rehabilitation, the a-ACLR group shows more significant changes than the c-ACLR group (p < 0.001). At 6 and 12 months, there are normal values of kinematic and kinetic values in a-ACLR compared with the results of the control group (p < 0.001). Conclusion: The study showed that postoperative rehabilitation provides significant effects in the kinematic, kinetic, and EMG gait parameters in acute ACLR than chronic ACLR subjects. Early surgical intervention and postrehabilitation are mandatory to get the significant effects in the clinical parameters in acute and chronic ACL injury.

3.
Burns ; 2021 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-33849715

RESUMO

BACKGROUND: Burns to the thorax are at high risk for long-term pulmonary complications due to chest muscle contractures and chronic inflammation in both adolescents and young adults. Few studies have investigated the effects of arm cycling exercise in those individuals. For that reason, this study examined pulmonary function, functional capacity, and quality of life (QOL) in adolescents with thoracic burns subsequent to 2-month arm cycling exercise programme. METHODS: A single-blinded, two-month randomized prospective controlled study was carried out between July 2019 and March 2020 on thirty adolescents with chest burns aged 11-17 years. They were randomized into two equal groups (n = 15), traditional physiotherapy programme (control group), and arm cycling exercise plus traditonal physiotherapy (arm cycling exercise group) for 2 consecutive months. Forced vital capacity (FVC), forced expiratory volume in one second (FEV1), six-minute walk test (6MWT), and Pediatric Quality of Life Inventory (PedsQL) were measured in both groups at baseline and after 2-month after intervention. RESULTS: No statistical significance was detected at baseline between control and arm cycling exercise groups (FVC, p = 0.903, FEV1, p = 0.835, 6MWT, p = 0.817, and PedsQL, p = 0.612). 2 months after intervention showed statistical improvements in the arm cycling exercise group in all measures (FVC, p = 0.001, FEV1, p < 0.0001, 6MWT, p = 0.001, and PedsQL, p = 0.001) however, the control group showed statistical improvements in FVC, p = 0.044 and FEV1, p = 0.024 with non-statistically significant changes in 6MWT, p = 0.145 and PedsQL, p = 0.067. The arm cycling exercise group showed greater improvements than control group in the outcome measures (FVC, p = 0.034, FEV1, p < 0.017, 6MWT, p = 0.037, and PedsQL, p = 0.021). CONCLUSIONS: This prospective study clearly demonstrated positive and beneficial influences of two-month arm cycling exercise in the optimization of pulmonary functions, functional performance, and QOL in adolescents suffering from chest burns and thereby eliminating post-burn complications.

4.
J Sport Rehabil ; 30(6): 884-893, 2021 Feb 16.
Artigo em Inglês | MEDLINE | ID: mdl-33596538

RESUMO

OBJECTIVE: To find the short-term psychological and hormonal effects of virtual reality training on chronic low back pain in American soccer players. DESIGN, SETTING, PARTICIPANTS: The 3-block random sampling method was used on 54 university American soccer players with chronic low back pain, and they were allocated into 3 groups: virtual reality training (VRT; n = 18), combined physical rehabilitation (n = 18), and control (n = 18) groups at University Hospital. They underwent different balance training exercises for 4 weeks. The participants and the therapist who is assessing the outcomes were blinded. Psychological (pain intensity and kinesiophobia) and hormonal (glucose, insulin, Homeostatic Model Assessment of Insulin Resistance, growth hormone, prolactin, adrenocorticotropic hormone, and cortisol) values were measured at baseline, after 4 weeks, and after 6 months. RESULTS: The baseline demographic, psychological, and hormonal data between the VRT, combined physical rehabilitation, and control groups show no statistical difference (P ≥ .05). Four weeks following training, the VRT group shows more significant changes in pain intensity and kinesiophobia than the combined physical rehabilitation and control groups (P < .001), and the improvement was noted in the 6-month follow-up. All the hormonal variables (glucose, insulin, growth hormone, prolactin, adrenocorticotropic hormone, and cortisol) show significant changes at 4-week training (P < .001), except for the Homeostatic Model Assessment of Insulin Resistance (P = .075) between the 3 groups. At 6-month follow-up glucose, prolactin, adrenocorticotropic hormone, and cortisol show more significant difference in the VRT group than the other 2 groups (P < .001). At the same time, insulin (P = .694), Homeostatic Model Assessment of Insulin Resistance (P = .272), and growth hormone (P = .145) failed to show significant changes between the groups. CONCLUSION: Training through virtual reality is an effective treatment program when compared with conventional exercise training programs from a psychological and hormonal analysis perspective in American soccer players with chronic low back pain.


Assuntos
Dor Lombar , Futebol , Realidade Virtual , Exercício Físico , Terapia por Exercício , Humanos
5.
Dis Markers ; 2021: 8866093, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33628339

RESUMO

Sarcopenia is the most common feature of hepatic cirrhosis characterized by progressive loss of muscle mass and function and increases permanently the mortality and morbidity rates among those patients. The incidence of sarcopenia in cirrhotic patients ranged 40-70% associating with impaired quality of life and augmented rates of infection. Based on these issues, this review is aimed at determining the prevalence and main causes of sarcopenia among cirrhotic patients and recognizing the recent diagnostic and physical treatment modalities that prevent risk factors for sarcopenia in those patients. No ideal modality is currently demonstrated for diagnosing sarcopenia in hepatic diseases, particularly cirrhosis; however, recent studies reported different diagnostic modalities for muscle function in different individuals including handgrip strength, skeletal muscle index, six-min walk test, liver frailty index, short physical performance battery, and radiological assessments for quadriceps and psoas muscles. Exercise training and therapeutic nutrition are strongly recommended for controlling sarcopenia in cirrhotic patients. The exercise program is designed and carried out on a frequent basis within an extensive scheduled time aimed at improving functional performance, aerobic capacity, and healthy conditions. Finally, a combination of exercise training and therapeutic nutrition is powerfully recommended to control sarcopenia in cirrhosis.


Assuntos
Exercício Físico/fisiologia , Cirrose Hepática/terapia , Fígado/patologia , Músculo Esquelético/patologia , Terapia Nutricional/métodos , Sarcopenia/terapia , Feminino , Força da Mão/fisiologia , Humanos , Cirrose Hepática/complicações , Cirrose Hepática/diagnóstico , Cirrose Hepática/patologia , Testes de Função Hepática , Masculino , Desempenho Físico Funcional , Qualidade de Vida/psicologia , Sarcopenia/complicações , Sarcopenia/diagnóstico , Sarcopenia/patologia , Fatores Sexuais
6.
Medicine (Baltimore) ; 99(51): e23555, 2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33371083

RESUMO

BACKGROUND: Isokinetic training (IKT) and core stabilization training (CST) are commonly used for balance training in musculoskeletal conditions. The knowledge about the effective implementation of these training protocols on radiological and biochemical effects in university football players with chronic low back pain (LBP) is lacking. OBJECTIVE: To find and compare the effects of isokinetic training and CST on radiological and biochemical effects in university football players with chronic LBP. DESIGN: Randomized, double-blinded controlled study. SETTING: University hospital. PARTICIPANTS: 60 LBP participants were randomized into isokinetic group (IKT; n = 20), core stabilization group (CST; n = 20) and the control group (n = 20) and received respective exercises for 4 weeks. OUTCOME MEASURES: Radiological (muscle cross sectional area & muscle thickness) and biochemical (C-reactive protein, tumor necrosis factor -α, interleukin [IL]-2, IL-4, IL-6) values were measured at baseline and after 4 weeks (immediate effect). RESULTS: The reports of the IKT, CST and control group were compared between the groups. Four weeks following training IKT group shows more significant changes in muscle cross sectional area (Psoas Major, Quadratus Lumborum, Multifidus and Erector Spinae muscles) and muscle thickness (Multifidus) than CST and control groups (p < 0.001). Biochemical measures such as C-reactive protein, tumor necrosis factor -α, IL-2, IL-4 and IL-6 also show significant improvement in IKT group than the other 2 groups (P < .001). CONCLUSION: Training through Isokinetic is an effective treatment program than conventional exercise programs in the aspect of radiological and biochemical analysis in university football players with chronic LBP, which may also help to prevent further injury. The present study can be used to improve the physical therapist's knowledge and clinical decision skills on LBP in football players.


Assuntos
Terapia por Exercício/métodos , Dor Lombar/terapia , Futebol , Adolescente , Adulto , Doença Crônica , Método Duplo-Cego , Feminino , Humanos , Mediadores da Inflamação/metabolismo , Masculino , Músculo Esquelético/fisiologia , Medição da Dor , Universidades , Adulto Jovem
7.
Artigo em Inglês | MEDLINE | ID: mdl-33178306

RESUMO

Objectives: Chronic nonspecific low back pain (chronic nsLBP) is one of the most common musculoskeletal disorders leading to disabilities and physical inactivity. Laser therapy was used in chronic nsLBP treatment; however, no previous studies have assessed the impacts of high-intensity laser therapy (HILT) versus low-level laser therapy (LLLT) on chronic nsLBP. This study compared the effects of HILT versus LLLT on individuals suffering from chronic nsLBP. Methods: The study was a randomized control trial. Sixty individuals with chronic nsLBP were enrolled in this study between May and November 2019. All participants were clinically diagnosed with chronic nsLBP. They were assigned randomly into three groups, 20 in each group. The first group received a program of LLLT, the second group received a program of HILT, and the third did not receive laser therapy (control group). Pain severity, disability, lumbar mobility, and quality of life were assessed before and after 12-week intervention. Results: Both LLLT and HILT groups showed a significant improvement of the Oswestry Disability Index (ODI), visual analogue scale (VAS), lumbar range of motion (ROM), and European Quality of Life (EuroQol) scores (p > 0.05), while the control group did not show significant changes (p > 0.05). Comparison among the three study groups postintervention showed significant differences in the outcome measures (p > 0.05), while comparison between the LLLT and HILT groups showed nonsignificant differences (p > 0.05). Conclusion: There are no different influences of LLLT versus HILT on chronic nsLBP patients. Both LLLT and HILT reduce pain and disability and improve lumbar mobility and quality of life in chronic nsLBP patients.

8.
Dis Markers ; 2020: 8829373, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32963638

RESUMO

Objectives: Congenital diaphragmatic hernia (CDH) is a birth defect affecting the respiratory functions, functional performance, and quality of life (QOL) in school-aged children. Rarely have studies been conducted to evaluate the impacts of respiratory muscle training on school-aged children with postoperative CDH. The current study was designed to evaluate the impacts of respiratory muscle training on respiratory function, maximal exercise capacity, functional performance, and QOL in these children. Methods: This study is a randomized control study. 40 children with CDH (age: 9-11 years) were assigned randomly into two groups. The first group conducted an incentive spirometer exercise combined with inspiratory muscle training (study group, n = 20), whereas the second group conducted only incentive spirometer exercise (control group, n = 20), thrice weekly for twelve consecutive weeks. Respiratory functions, maximal exercise capacity, functional performance, and pediatric quality of life inventory (PedsQL) were assessed before and after the treatment program. Results. Regarding the posttreatment analysis, the study group showed significant improvements in all outcome measures (FVC%, p < 0.001; FEV1%, p = 0.002; VO2max, p = 0.008; VE/VCO2 slope, p = 0.002; 6-MWT, p < 0.001; and PedsQL, p < 0.001), whereas the control group did not show significant changes (p > 0.05). Conclusion: Respiratory muscle training may improve respiratory functions, maximal exercise capacities, functional performance, and QOL in children with postoperative CDH. Clinical commendations have to be considered to include respiratory muscle training in pulmonary rehabilitation programs in children with a history of CDH.


Assuntos
Exercícios Respiratórios/métodos , Teste de Esforço/métodos , Hérnias Diafragmáticas Congênitas/reabilitação , Hérnias Diafragmáticas Congênitas/cirurgia , Espirometria/instrumentação , Criança , Terapia Combinada , Tolerância ao Exercício , Feminino , Hérnias Diafragmáticas Congênitas/fisiopatologia , Humanos , Masculino , Desempenho Físico Funcional , Qualidade de Vida , Resultado do Tratamento
9.
New Phytol ; 219(2): 697-713, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29726613

RESUMO

Cyst nematodes deliver effector proteins into host cells to manipulate cellular processes and establish a metabolically hyperactive feeding site. The novel 30D08 effector protein is produced in the dorsal gland of parasitic juveniles, but its function has remained unknown. We demonstrate that expression of 30D08 contributes to nematode parasitism, the protein is packaged into secretory granules and it is targeted to the plant nucleus where it interacts with SMU2 (homolog of suppressor of mec-8 and unc-52 2), an auxiliary spliceosomal protein. We show that SMU2 is expressed in feeding sites and an smu2 mutant is less susceptible to nematode infection. In Arabidopsis expressing 30D08 under the SMU2 promoter, several genes were found to be alternatively spliced and the most abundant functional classes represented among differentially expressed genes were involved in RNA processing, transcription and binding, as well as in development, and hormone and secondary metabolism, representing key cellular processes known to be important for feeding site formation. In conclusion, we demonstrated that the 30D08 effector is secreted from the nematode and targeted to the plant nucleus where its interaction with a host auxiliary spliceosomal protein may alter the pre-mRNA splicing and expression of a subset of genes important for feeding site formation.


Assuntos
Arabidopsis/genética , Arabidopsis/parasitologia , Núcleo Celular/metabolismo , Comportamento Alimentar , Regulação da Expressão Gênica de Plantas , Proteínas de Helminto/metabolismo , Interações Hospedeiro-Parasita/genética , Tylenchoidea/metabolismo , Processamento Alternativo/genética , Sequência de Aminoácidos , Animais , Genes de Plantas , Proteínas de Helminto/química , Estágios do Ciclo de Vida , Sinais de Localização Nuclear , Parasitos/metabolismo , Células Vegetais/metabolismo , Folhas de Planta/metabolismo , Raízes de Plantas/crescimento & desenvolvimento , Raízes de Plantas/metabolismo , Raízes de Plantas/parasitologia , Regiões Promotoras Genéticas/genética , Ligação Proteica , Interferência de RNA , Plântula/metabolismo , Tylenchoidea/crescimento & desenvolvimento , Regulação para Cima
10.
Indian J Med Res ; 145(5): 698-699, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28948964
12.
Malar J ; 15(1): 492, 2016 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-27663527

RESUMO

BACKGROUND: Plasmodium vivax is the most widely distributed human malaria parasite and accounts for approximately the same number of malaria cases as Plasmodium falciparum in India. Compared with P. falciparum, P. vivax is difficult to eradicate because of its tendency to cause relapses, which impacts treatment and control strategies. The genetic diversity of these parasites, particularly of the merozoite surface protein-3 alpha (msp-3α) gene, can be used to help develop a potential vaccine. The present study aimed to investigate the genetic diversity of P. vivax using the highly polymorphic antigen gene msp-3α and to assess the suitability of using this gene for population genetic studies of P. vivax isolates and was carried out in 2004-06. No recent study has been reported for MSP 3α in the recent decade in India. Limited reports are available on the genetic diversity of the P. vivax population in India; hence, this report aimed to improve the understanding of the molecular epidemiology of the parasite by studying the P. vivax msp-3α (Pvmsp-3α) marker from P. vivax field isolates from India. METHODS: Field isolates were collected from different sites distributed across eight states in India. A total of 182 blood samples were analysed by a nested polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique using the HhaI and AluI restriction enzymes to determine genetic msp-3α variation among clinical P. vivax isolates. RESULTS: Based on the length variants of the PCR products of Pvmsp-3α gene, three allele sizes, Type A (1.8 kb), Type B (1.5 kb) and Type C (1.2 kb) were detected among the 182 samples. Type A PCR amplicon was more predominant (75.4 %) in the samples compared with the Type B (14.3 %) and Type C (10.0 %) polymorphisms. Among all of the samples analysed, 8.2 % were mixed infections detected by PCR alone. Restriction fragment length polymorphism (RFLP) analysis involving the restriction enzymes AluI and HhaI generated fragment sizes that were highly polymorphic and revealed substantial diversity at the nucleotide level. CONCLUSIONS: The present study is the first extensive study in India using the Pvmsp-3α marker. The results indicated that Pvmps-3α, a polymorphic genetic marker of P. vivax, exhibited considerable variability in infection prevalence in field isolates from India. Additionally, the mean multiplicity of infection observed at all of the study sites indicated that P. vivax is highly diverse in nature in India, and Pvmsp-3α is likely an effective and promising epidemiological marker.

13.
BMC Med Educ ; 16: 162, 2016 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-27287316

RESUMO

BACKGROUND: International Medical Graduates (IMGs) are known to perform less well in many postgraduate medical examinations when compared to their UK trained counterparts. This "differential attainment" is observed in both knowledge-based and clinical skills assessments. This study explored the influence of culture and language on IMGs clinical communication skills, in particular, their ability to seek, detect and acknowledge patients' concerns in a high stakes postgraduate clinical skills examination. Hofstede's cultural dimensions framework was used to look at the impact of culture on examination performance. METHODS: This was a qualitative, interpretative study using thematic content analysis of video-recorded doctor-simulated patient consultations of candidates sitting the MRCP(UK) PACES examination, at a single examination centre in November 2012. The research utilised Hofstede's cultural dimension theory, a framework for comparing cultural factors amongst different nations, to help understand the reasons for failure. RESULTS: Five key themes accounted for the majority of communication failures in station 2, "history taking" and station 4, "communication skills and ethics" of the MRCP(UK) PACES examination. Two themes, the ability to detect clues and the ability to address concerns, related directly to the overall construct managing patients' concerns. Three other themes were found to impact the whole consultation. These were building relationships, providing structure and explanation and planning. CONCLUSION: Hofstede's cultural dimensions may help to contextualise some of these observations. In some cultures doctor and patient roles are relatively inflexible: the doctor may convey less information to the patient (higher power distance societies) and give less attention to building rapport (high uncertainty avoidance societies.) This may explain why cues and concerns presented by patients were overlooked in this setting. Understanding cultural differences through Hofstede's cultural dimensions theory can inform the preparation of candidates for high stakes bedside clinical skills examinations and for professional practice.


Assuntos
Competência Clínica/normas , Características Culturais , Avaliação Educacional/métodos , Médicos Graduados Estrangeiros/normas , Linguística , Médicos/normas , Adulto , Feminino , Humanos , Masculino , Pesquisa Qualitativa , Análise e Desempenho de Tarefas , Reino Unido
14.
BMC Med Educ ; 16: 66, 2016 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-26887892

RESUMO

BACKGROUND: A portfolio of supporting information (SI) reflecting a doctor's entire medical practice is now a central aspect of UK appraisal for revalidation. Medical revalidation, introduced in 2012, is an assessment of a doctor's competence and passing results in a five yearly license to practice medicine. It assesses of a doctor's professional development, workplace performance and reflection and aims to provide assurance that doctors are up-to-date and fit to practice. The dominant assessment mechanism is a portfolio. The content of the revalidation portfolio has been increasingly prescribed and the assessment of the SI is a fundamental aspect of the appraisal process which ultimately allows Responsible Officers (ROs) to make recommendations on revalidation. ROs, themselves doctors, were the first to undergo UK revalidation. This qualitative study explored the perceptions of ROs and their appraisers about the use of this portfolio of evidence in a summative revalidation appraisal. METHODS: 28 purposefully sampled London ROs were interviewed following their revalidation appraisal and 17 of their appraisers participated in focus groups and interviews. Thematic analysis was used to identify commonalities and differences of experience. RESULTS: SI was mostly easy to provide but there were challenges in gathering certain aspects. ROs did not understand in what quantities they should supply SI or what it should look like. Appraisers were concerned about making robust judgements based on the evidence supplied. A lack of reflection from the process of collating SI and preparing for appraisal was noted and learning came more from the appraisal interview itself. CONCLUSIONS: More explicit guidance must be available to both appraisee and appraiser about what SI is required, how much, how it should be used and, how it will be assessed. The role of SI in professional learning and revalidation must be clarified and further empirical research is required to examine how best to use this evidence to make judgments as part of this type of appraisal.


Assuntos
Competência Clínica/normas , Avaliação de Desempenho Profissional/normas , Licenciamento em Medicina/normas , Médicos/normas , Garantia da Qualidade dos Cuidados de Saúde/normas , Medicina Estatal/normas , Avaliação de Desempenho Profissional/métodos , Inglaterra , Grupos Focais , Humanos , Entrevistas como Assunto , Londres , Pesquisa Qualitativa , Garantia da Qualidade dos Cuidados de Saúde/métodos , Autoavaliação (Psicologia)
15.
Indian J Med Res ; 144(3): 440-446, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28139543

RESUMO

BACKGROUND & OBJECTIVES: Ventilator-associated pneumonia (VAP) is an important hospital-acquired infection with substantial mortality. Only a few studies are available from India addressing the microbiological aspects of VAP, which have been done with small study populations. This study was carried out in the intensive care units (ICUs) of a tertiary care hospital to assess the profile of pathogens and to determine the pattern of antimicrobial resistance. METHODS: This was a retrospective study of clinically suspected cases of VAP. Over a three year period, a total of 247 cases in 2011, 297 in 2012 and 303 in 2013 admitted in ICUs on mechanical ventilation with clinical evidence of VAP were included in our study. The endotracheal aspirate samples from these suspected cases were subjected to quantitative culture technique, and colony count of ≥10[5] colony forming units/ml was considered significant. Antimicrobial susceptibility test for the isolates was done. RESULTS: VAP rates of 44.1, 43.8 and 26.3 were seen in 2011, 2012 and 2013, respectively. In all the three years, non-fermentative Gram-negative bacilli were the predominant organisms, followed by Pseudomonas spp. and Klebsiella spp. Staphylococcus aureus exhibited a downwards trend in prevalence from 50.0 per cent in 2011 to 34.9 per cent in 2013. An increase in vancomycin-resistant enterococci was seen from 4.3 per cent in 2012 to 8.3 per cent in 2013, while methicillin resistance amongst the S. aureus crossed the 50 per cent mark in 2013. An increasing trend in resistance was shown by Pseudomonas spp. for piperacillin-tazobactam (PTZ), amikacin and imipenem (IPM). For the non-fermenters, resistance frequency remained very high except for IPM (33.1%) and polymyxin-B (2.4%). INTERPRETATION & CONCLUSIONS: Our findings show VAP as an important problem in the ICU setting. The incidence of multidrug-resistant pathogens was on the rise. The resistance pattern of these pathogens can help an institution to formulate effective antimicrobial policy. To have a comprehensive pan-India picture, multicentric studies are needed.


Assuntos
Farmacorresistência Bacteriana Múltipla , Resistência a Meticilina , Pneumonia Associada à Ventilação Mecânica/tratamento farmacológico , Pneumonia Associada à Ventilação Mecânica/microbiologia , Amicacina/uso terapêutico , Humanos , Imipenem/uso terapêutico , Índia , Unidades de Terapia Intensiva , Klebsiella/efeitos dos fármacos , Klebsiella/patogenicidade , Ácido Penicilânico/análogos & derivados , Ácido Penicilânico/uso terapêutico , Piperacilina/uso terapêutico , Combinação Piperacilina e Tazobactam , Pneumonia Associada à Ventilação Mecânica/patologia , Pseudomonas/efeitos dos fármacos , Pseudomonas/patogenicidade , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/patogenicidade , Centros de Atenção Terciária , Enterococos Resistentes à Vancomicina/efeitos dos fármacos , Enterococos Resistentes à Vancomicina/patogenicidade
16.
BMC Med Educ ; 15: 152, 2015 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-26392086

RESUMO

BACKGROUND: To evaluate NHS England London region's approach to the revalidation appraisal of responsible officers in London, exploring perceptions of the quality and impact of the appraisal process. Revalidation is the process which aims to ensure doctors in the UK are up-to-date and fit to practice medicine thus improving the quality of patient care. Revalidation recommendations are largely premised on the documentation included in annual appraisals, which includes the professional development a doctor has undertaken and supporting information about their practice. METHODS: A pan-London qualitative study exploring the views of responsible officers and their appraisers about the revalidation appraisal process. The study aimed to gain an in-depth understanding of the experiences and perceptions of the participants. Responsible officers were purposefully sampled to represent the broadest range of designated bodies. Data analysis generated themes pertaining to quality and impact of appraisal for revalidation with the potential to feed into and shape the evolving system under investigation. RESULTS: The central importance of highly skilled appraisers was highlighted. Both groups reported educational opportunities embedded within the appraisal process. Independent appraisers, not matched by clinical speciality or place of work, were considered to take a more objective view of a responsible officer's practice by providing an 'outsider perspective'. However, covering the breadth of roles, in sufficient depth, was challenging. Participants reported a bias favouring the appraisal of the responsible officer role above others including clinical work. Appraisal and revalidation was perceived to have the potential to improve the healthcare standards and support both personal development and institutional quality improvement. CONCLUSIONS: Responsible officers play a central role in the revalidation process. Getting responsible officer appraisal right is central to supporting those individuals to in turn support doctors and healthcare organisations in continuous quality improvement. The complexity and importance of the role of responsible officer may make achieving an appraisal of all roles of such individuals problematic. This evaluation suggests responsible officer appraisal was perceived as educational and effective.


Assuntos
Governança Clínica , Credenciamento , Médicos/normas , Competência Clínica/normas , Governança Clínica/organização & administração , Governança Clínica/normas , Credenciamento/organização & administração , Credenciamento/normas , Humanos , Entrevistas como Assunto , Londres , Reino Unido
18.
JRSM Short Rep ; 3(9): 62, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23323202

RESUMO

OBJECTIVES: To design a tool to explore current leadership teaching in an undergraduate curriculum, using the medical leadership competency framework (MLCF) DESIGN: An online questionnaire was designed based on the MLCF competences and sent to all course leads at Imperial College, London in Autumn 2011 SETTING: Imperial College, London PARTICIPANTS: Sixty-nine course leads were invited to participate in the questionnaire study MAIN OUTCOME MEASURES: Course leads were asked whether they teach each MLCF competence, which teaching methods they use, and how long they spend teaching each competency RESULTS: Overall there was a 78% questionnaire response rate (54/69). From the questionnaires received it was possible to extrapolate results across the remaining courses to achieve a 100% response rate. We were then able to produce a map of current leadership teaching showing that all MLCF competences are taught to varying degrees across the curriculum. The tool does not however provide information on the quality of teaching provided, or what students learn CONCLUSIONS: There is a strong emphasis on the development of teaching leadership skills to undergraduates in Tomorrow's Doctors 2009 (TD09). It is difficult to know what teaching occurs across the curriculum of a large medical school. The design of a simple, electronic questionnaire will enable medical schools to map their current leadership teaching to the TD09 outcomes. This will help to inform further curriculum development and integration as well as signposting of learning opportunities.

19.
Med Teach ; 33(7): e388-96, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21696273

RESUMO

BACKGROUND: Simulation is increasingly used as a teaching tool and in assessment. The Ventriloscope® (VS) is a new auscultation simulator. This modified stethoscope allows pre-recorded sounds (activated wirelessly) to be integrated with a simulated patient (SP, professional actor). AIMS: This study explores the instrument's potential for overcoming limitations of current objective structured clinical examination (OSCE) assessment by increasing validity while retaining reliability. METHODS: After training SPs to synchronise the device with their breathing (recreating abnormal signs), we evaluated the VS during a third year undergraduate medical student OSCE. Students (n = 385), examiners (n = 19) and SPs (n = 10) completed post-exam questionnaires which were analysed using a coding framework. OSCE performance data were analysed using Stata 10. RESULTS: When 'compared to their usual stethoscope' 40% of students found no difference in using the VS; 69% found it easier to identify sounds; 68% found examination with the VS very or fairly realistic when 'compared to examining a real patient'. Examination scores were comparable with other OSCE stations. CONCLUSIONS: The VS reliably provided consistent 'abnormal' auscultatory signs within an OSCE framework. Using a VS may increase OSCE validity, allowing examiners to assess students' application of knowledge in a realistically simulated setting. The VS can help bridge the gap between simulation and real patients.


Assuntos
Auscultação/instrumentação , Competência Clínica/normas , Exame Físico/normas , Estudos de Avaliação como Assunto , Humanos , Londres , Estudantes de Medicina , Inquéritos e Questionários
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